The City of Portland is responsible to monitor biodiesel production in Oregon and the City of Portland. The City will use the information collected from this form to determine if biodiesel production levels are meeting the City of Portland’s qualifying feedstock requirements, and to provide information to interested parties about biodiesel production levels in Oregon.

Please complete and submit this form, detailing the previous month’s production.
A month means the 1st day of the month through the last day of the month.
The forms shall be submitted by email to crystle.cowen@portlandoregon.gov or via FAX at (503) 823-7915.

Month/Year*

Oregon Production Facility Name*

Mailing Address*

Location Address*

Gallons Produced from Oregon Grown Feedstock*

Oregon Grown Feedstock means the plant or animal matter from which a biofuel is derived. The source of the Oregon Grown Feedstock and the production levels cited above must be documented; and the City may inspect records to verify the origin of the feedstock and or/the production levels.

Gallons Produced from Used Cooking Oil*

Total Gallons of Biodiesel Produced from Oregon Grown Feedstock and Used Cooking Oil*

Gallons Produced from Other Feedstock*

Other Feedstock means feedstock grown outside of Oregon.

Total Gallons of Biodiesel Produced*

Print Name of Production Facility Representative *

Date*

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